Thrombolysis - Thrombolytic Therapy

Overview

Thrombolysis, also commonly referred to as thrombolytic therapy, is a therapy to help prevent damage to tissues and organs caused by conditions such as stroke or heart attack.
Your doctor may inject clot-busting drugs through an IV or catheter directly into a blockage during thrombolytic therapy. The procedure could also involve using a mechanical device that physically breaks up the clot.

Candidates for thrombolytic therapy

Thrombolysis is often recommended to prevent damage due to:

• Stroke - blocked arteries in the brain
• Heart attack - Blocked arteries in the heart
• Pulmonary embolism - Blocked arteries in the lungs
• Deep vein thrombosis (DVT) - Blocked veins in the leg
• Leg ischemia - Blocked arteries in the leg
• Blocked dialysis fistulas
• Blocked surgical bypasses

Preparing for thrombolytic therapy

Because thrombolytic therapy is given in emergency situations, there are few things you can do to prepare. If your doctor performs an angiography before or during thrombolytic therapy, your doctor will get a picture of your blood vessels. 

Expectations during thrombolytic therapy

Thrombolysis is performed in one of two ways:

System thrombolysis

• System thrombolysis is performed through a peripheral IV. This is used to treat a heart attack, stroke, or pulmonary embolism.
• During systemic thrombolysis, the clot-busting drug is delivered to the clot through an IV line in the arm. It is performed in the intensive care unit as your heart and lung functions are monitored. The medication will go through the bloodstream until it reaches the clot. This helps dilute the drug to reduce the chances of bleeding.

Catheter-directed thrombolytic therapy

• Catheter-directed thrombolytic therapy is performed through a catheter that is navigated to the clot. Catheter-directed thrombolytic therapy is used to treat acute deep vein thrombosis. These clots develop in the leg, thigh, or pelvic area and can travel to other areas of the body. If a DVT travels to the lungs, it is a pulmonary embolism that can cause chest pain, shortness of breath, and potentially death.
• Your doctor may recommend thrombolysis if blood thinners did not dissolve the DVT or pulmonary embolism. After the procedure, you should feel less pain and have less swelling.
• During thrombolytic therapy for DVT, you will be given medication to relax, and your surgeon will numb the area being treated. A catheter is threaded into the body through a puncture in the groin, neck, or behind the knee. Medicine is injected through the tube and into the clot. When necessary, a small machine is used to break up the clot.

Recovering from thrombolytic therapy

You will stay in the hospital for at least a day after thrombolytic therapy for monitoring. You will likely receive fluids, antibiotics, and painkillers. You will be instructed to keep your limb straight for several hours if a catheter was inserted through an artery in your leg or arm.

You will be discharged when bleeding from the access site stops and vital signs return to normal.

Your care team will give you instructions about how quickly you can return to your regular daily routine after returning home. It is also essential to follow your doctor's instructions about follow-up care and appointments.

When to seek care

If you think you may need a thrombolysis, start by voicing your concerns and symptoms to your primary care provider. From there, your doctor may suggest seeing a cardiologist for more specialized treatment.